Category: Drugs

Are you telling the truth? Please doctor, help me! I feel like there’s something the propecia company and doctors are not telling us. I have experienced worse hairloss due to propecia. I used to be able to pull out a few stray hairs and my hairline was slightly receding. Similar to many patients I’ve seen post on your site, now I’m balding all over and I can pull out about 15 hairs at time. What’s the real deal. Are doctors lying to us to make a buck? I feel like it can’t be an issue besides mpb for all these men that have taken the drug and then experienced worse hair loss! It’s been about 6 months for me. Should I just forget about the drug and quit? Thank you for your time! I’m trying to see a doctor, but they’re all booked for months. I’d really appreciate in your input.

The medication finasteride (Propecia) is proven to decrease the rate of hair loss in most young men and in some cases increase the density and bulk of the scalp hair in the crown and top of the head. This is based on several clinical studies. Some patients may experience increased shedding in the first few months of its use, which usually stops spontaneously. I generally examine my patients before starting them on finasteride. Could you have some other cause of hair loss (other than pure genetic patterned balding)?

The miniaturization study is the best method of assessing the effectiveness of medical treatment as opposed to subjective self-evaluation by the patient. My suggestion to you is to see a good hair transplant doctor to document your miniaturization status and repeat this study every 6 to 12 months while on the medication. You needs numbers placed on the miniaturization process so that you can see from any point in time where you are and where you were.

Hi Dr. Rassman,
I was just wondering. My family has some history of baldness, on my mom’s side, with my grandfather going balding, and having a receding hairline far back at my age. However, I still have a maturing hairline, but over the last year, I have been under heavy stress, as I am pre-med. I’ve lost hair in the front of my head, behind my hairline, but no thinning beyond that. HOwever, my father, thinking it is Telogen Effluvium (he is a physician, and loses hair in the same pattern when he gets stressed) gave me some rogaine. I’ve been applying it for barely 3 weeks now, and I can feel a huge amount of stubble, even in weird areas it shouldn’t be filling in, like the temples. Shouldn’t it take longer to work if it is male pattern baldness? Or is the minoxidil likely just forcing the schocked hair follices back into anagen?
Thanks so much

Yes, this is an unusual response with classic genetic patterned hair loss. If you had telogen effluvium it might reverse rapidly as you reported. To be on the safe side, I always like to get a diagnosis with your hair mapped out for miniaturization to determine if you have a pattern thinning occurring. By knowing if you have a genetic hair loss component, you can create a Master Plan should this happen again.

I have read about a combination of products that can be used to slow or stop hair loss. The Ultimate Hair Stack was recommended by Will Brink. Any comments to the following: http://www.dolfzine.com/page700.htm

This is interesting reading. I learned that there are more drugs out there that can bring about hair regrowth (Cyclosporine, for example), but are known to be dangerous. I caution anyone from trying the unproven drugs discussed here. Knowledge is power, so it does make good reading.

I have a question about Propecia. In my country (China), a generic is available OTC without a prescription. While we do have clinics specializing in hair loss, virtually all the doctors just push clients to do expensive and dangerous grafts, even when it’s not needed. I have had considerably thinning at the front of my hairline the last three years, and really up onto the crown. My temples aren’t too affected, so I have a hard time seeing myself matching a Norwood too clearly, but my dad is mostly bald on top. I also have dense body hair, which I’ve read is usually caused by the same chemical causing hair loss.

It seems likely this is DHT-caused, and I would like to start taking Propecia. I just have one question: if I am wrong, my hair loss has another cause, and it’s not MPB, it will obviously continue regardless of Propecia. Would quitting Propecia if this turns out to be true cause any kind of “shock loss” that I may not have gone through otherwise? I know if Propecia is helping you out and you quit it, nature comes back to get you with a vengeance, but what if you’re taking it and your loss isn’t being caused by DHT?

Just something I’ve been curious about.

These are important questions. First of all, Propecia (finasteride) at the 1mg dose adequately slows down hair loss in all men undergoing genetic hair loss. I am firm about this opinion so if you are thinning, then finasteride is a critical correct step in the process. If you stop taking it, you develop what I call catch-up hair loss, which means that all of the benefits will be reverse from the day you started to take the drug. The drug must be maintained for your lifetime to hold any benefits that it brings. Even with the drug, it may not stop the hair loss, so hair transplants may be the right solution. In my opinion, it is wrong to undergo a hair transplant without taking finasteride if you are under the age of 35-40. For those people who are taking finasteride without balding of thinning, stopping it after they start it will have no effect on normal hair.

i was wondering, i notice finasteride and dutasteride are metabolized in the liver by a bit different processes, i know they say dutasteride (type 1/2 in) since inhibits both may have more side effects, but i was wondering (as far as liver-wise) would dutasteride be less of a burden on the liver since only .5mg compared to fin 1mg, and any recent info as to type 1 AR role in hair loss if any?

The term burden is not correctly used. When a person has known liver disease, the rate at which the liver metabolizes drugs (and other metabolites) is slower. That means that the drug level may be higher in people with active liver disease when taking a standard dose. This can be managed with dose reduction so that the proper blood levels are maintained. Knowing that there is liver disease should direct the doctor to check blood levels of the drugs that are metabolized by the liver.